Licensed Vocational Nursing Program

LICENSED VOCATIONAL NURSING PROGRAM

1ST SEMESTER FUNDAMENTALS

CLIENTS WITH SPECIAL NEEDS

CHAPTER 47 - MOBILITY AND IMMOBILITY

INTR7ODUCTION

Immobilization can adversely affect a client’s total well-being, including the physiological, psychosocial and developmental dimensions. Immobilization may result from illness, a therapeutic intervention essential to facilitate wound healing, proper alignment of skeletal trauma, or rest following an illness and it involves many hazards and risks. A nurse must plan appropriate interventions to prevent these hazards or to minimize them when they do occur.

OBJECTIVES

Upon completion of this unit, the student will be able to:

A. Theory 1. Define immobility, bed rest, with BRP, decubitus ulcer, pressure sore, ischemia, renal calculus, thrombus, emboli, P.E. 2. Discuss benefits and hazards of bed rest. 3. Describe alternations in respiratory function associated with immobility. 4. Discuss the mechanism of orthostatic hypertension. 5. Define the Valsalva maneuver. 6. Describe how immobilization increases cardiac workload. 7. Describe the mechanism of thrombus formation. 8. Identify musculoskeletal changes associated with immobility. 9. List the alterations in gastrointestinal functioning associated with immobility. 10. List the alterations in genitourinary functioning associated with immobility. 11. Describe the psychosocial effects of immobilization and the nursing interventions used to minimize those effects.

ASSIGNMENT

A. Read Chapter 47- Potter & Perry – Critical Thinking Exercises # 1, 4, and Review Questions

B. Study Guide for Chapter 47  Chapter 47 Mobility and Immobility

 Scientific Knowledge Base: Nature of Movement

 Physiology and Regulation of Movements  Skeletal system o Provides attachments for muscles and ligaments o Provides leverage for movement  Skeletal muscles o Help movement of bones and joints  Nervous system o Regulates movement and posture

 Pathological Influences on Mobility

 Mobility and Immobility  Mobility o The ability to move about freely  Immobility o Inability to move about freely  Bed rest o An intervention that restricts clients for therapeutic reasons

 Systemic Effects

 Psychosocial Effects  Emotional and behavioral responses o Hostility, giddiness, fear, anxiety  Sensory alterations o Sleep-wake alterations  Changes in coping o Depression, sadness, dejection

 Developmental Changes Assessment  Mobility o ROM o Exercise and activity tolerance o Body alignment o Standing o Sitting o Lying o Assessment

 Immobility o Metabolic o Respiratory o Cardiovascular o Musculoskeletal o Integumentary o Elimination o Psychosocial o Developmental

 Nursing Diagnosis and Planning  A nursing diagnosis will be selected from the NANDA-I list after the assessment has been made.  The planning phase will establish client goals and outcomes.

 Implementation Acute Care  Metabolic o Provide high-protein, high-caloric diet with vitamin B and C supplements  Respiratory o Cough and deep breathe every 1 to 2 hours o Chest physiotherapy

 Implementation  Cardiovascular o Progress from bed to chair to ambulation o SCDs, TED hose, and leg exercises  Musculoskeletal o Passive ROM o CPM o Active ROM

 Implementation  Integumentary system o Reposition every 1 to 2 hours o Skin care  Elimination system o Adequate hydration o Diet rich in fluids, fruits, vegetables, and fiber  Implementation  Positioning techniques o Fowler’s o Supine o Prone o Side lying o Sims  Transfer

 Evaluation  Needed to gauge the effectiveness of specific interventions designed to promote body alignment, improve mobility, and protect the client from hazards of immobility